Referrals for complications following hysteroscopic sterilisation: characteristics associated with symptomatic patients after the Essure procedure

ABSTRACT

Objective: This report summarises recent experience with a series of symptomatic Essure® patients with an emphasis on clinical presentation, preoperative imaging, surgical intervention, and outcome. Methods: This case series presents Essure® patients (n = 7) who sought medical consultation for various complications. This retrospective analysis is based on consultations during a six-month interval beginning in April 2015. Results: In this sample, mean (± SD) patient age was 35.9 ± 3.4 yrs. The gravida/parity status was 3.6 ± 1.1 and 2.4 ± 1.4, respectively. Average duration of exposure to Essure® coils among these patients was 25.6 ± 24.5 (range 5–67) months. Except for one woman, these patients had hysteroscopic sterilisation (HS) either with heavy sedation or under general anaesthesia. More than two Essure® devices were implanted in two women. Complications reported after HS included device migration, coil fragmentation, tissue perforation, and vaginal expulsion of Essure® fragment. Three of seven women have required hysterectomy. Conclusion: The current series offers evidence of migration of contraceptive coils as well as Essure® inserts perforating tissue and being spontaneously expelled. Evaluation of symptomatic HS patients should include determining how many devices have been implanted, as some women have more than two.

Chinese abstract

本报告着重从临床表现、术前影像学、外科干预和结局等方面总结了有着一系列症状的Essure术后患者的近期问题。方法：本报告列举了一些因为各种各样的并发症寻求医疗咨询的Essure术后的患者（共7例）这项回顾性分析是建立在从2015年4月开始的每隔6个月一次的咨询基础上。结果：在这些样本中，患者的平均年龄是35.9±3.4岁。孕次/产次分别是3.6±1.1和2.4±1.4。这些患者应用Essure螺旋线圈的时间为5-67月，平均25.6±24.5个月。除一名妇女外，其他患者都是在大剂量镇静或全身麻醉状态下进行宫腔镜绝育术（HS）。其中的2个患者植入了2个以上的Essure装置。行宫腔镜绝育术后，已报道的并发症包括节育装置移位、线圈断裂、组织穿孔和破碎的Essure经阴道自发排出。七名妇女中有三名都进行了子宫切除术。结论：目前这些患者为Essure 避孕装置移位以及Essure导致组织穿孔和自发排出提供了证据。因为一些妇女的Essure植入数量超过2个，对有症状的宫腔镜节育术后患者的评估应包括Essure的植入数量。

KEYWORDS:

• Essure
• expulsion
• hysterectomy
• migration
• perforation
• sterilisation

Disclosure statement

The authors disclose no conflict of interest.